﻿<%@ page language="C#" masterpagefile="~/Default.master" autoeventwireup="true" inherits="PatientInfo, App_Web_patientinfo.aspx.cdcab7d2" title="Patient CRM" %>

<asp:Content ID="Content1" ContentPlaceHolderID="head" Runat="Server">
</asp:Content>
<asp:Content ID="Content2" ContentPlaceHolderID="ContentPlaceHolder1" Runat="Server">

    <div style="width: 100%;" class="box">
        <div class="topleft">
            <div class="topright">
                <div class="innerleft">
                    <h4>
                      <asp:Localize ID="lLinksTitle" meta:resourcekey="resLinksTitle" runat="server" />
                    </h4>
                </div>
                <div class="innerright">
                    <h4>
                        <asp:Localize ID="lTitle" meta:resourcekey="resTitle" runat="server" />   
                    </h4>
                </div>
                <div class="r">
                </div>
            </div>
        </div>
        <div class="mid">
            <div class="innerleft">
                <div>
                    <a href="Default.aspx">
                        <asp:Localize ID="lLinks1" meta:resourcekey="resLinks1" runat="server" />    
                    </a>
                    -
                    <a href="questiond.aspx">
                        <asp:Localize ID="lLinks2" meta:resourcekey="resLinks2" runat="server" />
                    </a>
                </div>
            </div>
            <div class="innerright">
                <div></div>
            </div>
            <div class="r">
            </div>
        </div>
        <div class="bottomleft">
            <div class="bottomright">
            </div>
        </div>
    </div>
    
    <div class="r"></div>

    <div id="long-formcontainer">
        <div>
            <label><asp:Localize ID="lPatientName" meta:resourcekey="resPatientName" runat="server" /></label>
            <asp:TextBox ID="txtPatientName" CssClass="langDir" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lNationalCode" meta:resourcekey="resNationalCode" runat="server" /></label>
            <asp:TextBox ID="txtNationalCode" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lIDNumber" meta:resourcekey="resIDNumber" runat="server" /></label>
            <asp:TextBox ID="txtIDNumber" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lBirthDate" meta:resourcekey="resBirthDate" runat="server" /></label>
            <asp:TextBox ID="txtBirthDate" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lFatherName" meta:resourcekey="resFatherName" runat="server" /></label>
            <asp:TextBox ID="txtFatherName" CssClass="langDir" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lTel" meta:resourcekey="resTel" runat="server" /></label>
            <asp:TextBox ID="txtTel" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lEmail" meta:resourcekey="resEmail" runat="server" /></label>
            <asp:TextBox ID="txtEmailAddress" runat="server" />
        </div>
        
        <div>
            <label><asp:Localize ID="lFamiliarity" meta:resourcekey="resFamiliarity" runat="server" /></label>
            <asp:TextBox ID="txtFamiliarity" CssClass="langDir" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lDescription" meta:resourcekey="resDescription" runat="server" /></label>
            <asp:TextBox ID="txtDescription" CssClass="langDir" TextMode="MultiLine" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lAddress" meta:resourcekey="resAddress" runat="server" /></label>
            <asp:TextBox ID="txtAddress" CssClass="langDir" TextMode="MultiLine" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lVIP" meta:resourcekey="resVIP" runat="server" /></label>
            <asp:CheckBox ID="cbVIP" runat="server" />
        </div>
        <div>
            <label><asp:Localize ID="lFileNumber" meta:resourcekey="resFileNumber" runat="server" /></label>
            <asp:TextBox ID="txtFileNumber" runat="server" />
        </div>
        <div id="divQuestionType" runat="server">
            <label><asp:Localize ID="lFileType" meta:resourcekey="resFileType" runat="server" /></label>
            <asp:DropDownList ID="ddlQuestionTypes" DataTextField="Description" 
                DataValueField="Id" AppendDataBoundItems="true" runat="server" 
                AutoPostBack="True" 
                onselectedindexchanged="ddlQuestionTypes_SelectedIndexChanged" />
        </div>
    </div>
    
    <div id="q-formcontainer">
        <div id="divQuestionArea" style="border:0;" runat="server">
             <asp:Repeater ID="rQuestions" runat="server">
                <ItemTemplate>
                  <div>
                    <asp:Label ID="lblRepeaterId" Text='<%# Bind("Id") %>' runat="server"></asp:Label>
                    <label class="langDir"><%# Eval("QuestionDesc")%></label>
                    <asp:TextBox ID="txtAnswer" CssClass="langDir" Text='<%# Bind("AnswerDesc") %>' TextMode="MultiLine" runat="server" />
                  </div>
                </ItemTemplate>
             </asp:Repeater>
        </div>
    </div>
    
    <div class="s"></div>
    
    <label><asp:Localize ID="lImmediateVisit" meta:resourcekey="resImmediateVisit" runat="server" /></label>
    <asp:CheckBox ID="cbImmediateVisit" Checked="true" runat="server" />
    
    <div class="s"></div>
    
    <div class="cssButtonSize-smallest cssButtonSide-lang">
     <div class="cssButton cssButtonColor-orange">
         <div class="cssButtonOuter">
            <div class="cssButtonMiddle">
              <div class="cssButtonInner">
                <asp:Button ID="btnSave" runat="server" meta:resourcekey="resBtnSave"
                      onclick="btnSave_Click" />
              </div>
            </div>
         </div>
     </div>
    </div>
    
</asp:Content>

